No information will be posted on the Love Quilts Australia website with the exception
of the first name and last initial of the child, the birthdate of the child,
the main diagnosis of the illness and the biography. All other info will be
kept private and only given to those who will be quilting and posting the quilt
to your child.

Child Details

Child name:

(Public)

Date of birth:

(Public)

Main diagnosis: (Please use medical names)

(Public)

Date of diagnosis:

(Public)

Other diagnosis:

(Public)

Biography:

(Public)

Begin story from birth, then signs of illness, diagnosis and what he/she has been
through until today. Please write at least 2 paragraphs. This information will be posted
on the Love Quilts Australia webpage created for your child.

Webpage for child: (optional)

(Public)

Webpage 2 for child: (optional)

(Public)

Child's Interests
and favourite colour:(please make this listing as detailed as you can - in particular we use favourite colour to assist in selecting suitable fabric for the quilt)

(Public)

Select photo of child:

(Public)

Photo must be submitted before child is featured for a quilt. If you are unable to upload a photo electronically, you may
alternatively you may snail mail a photo or send it by email to contact@lovequiltsaustralia.com

If another website has featured your child with a picture, let us know the web address and we can retrieve a photo from there.

Family Details - * All information below will be kept private!*

Full Name of Mother:(First and Last)

(Private)

and/or Full Name of father:(First and Last)

(Private)

Last name of the family
(if different from child):

(Private)

Home Address:

(Private)

City, County, Postcode:

(Private)

Snail mail address where quilt should be mailed:

(Private)

Phone Number:(only used if we are unable to reach you via email and will be kept private) -

(Private)

Correct email address:(kept private)

(Private)

Alternative Email address:(for us to use if main address doesn't work for some reason)

(Private)

Form submitted by:(if submitted by anyone other than the parent, permission must be received from the parent before the child is featured) -

(Private)

Theme of Quilt

Below is a listing of theme choices that we feel will have enough pattern
choices for the stitchers. We do try and fill special requests when we can,
but those requests must be approved in advance. Please pick 3 possible themes you would like
and put them in preferred order. We will use only ONE of the requested themes for your child's
quilt! We will try and fulfil your first request if possible, but please know that we
may approve one of the others. This might occur if there is over use of the theme for
that year (makes it hard to get stitchers to sign up)
Please fill in all 3 spaces from the themes listed below.

Please look over this listing carefully before making your choices.

If possible, please pick only one....unless you are combining two similar themes... eg Heroes and Patriotic together.